(1) The Memorandum of appeal under sub section (i) of section i of the Act shall be submitted to the appellate authority with a copy thereof lo the opposite party and the 'controlling authority' either through ddivery in person or under registered post with acknowledgement due.
• Application for recovery or gratuity.
Display of abstract of the Act and rules.
9
(2) The Memorandum of appeal shall contain the facts of the cas~. the decision of the controlling authority, the grounds of appeal and the relief sought.
(3) There shall be appended to the Memoran dum of appeal a certified copy of the finding of the controlling authority and direction for payment of gra tuity.
( 4) On receipt of the copy of Memorandum of appeal, the 'controlling authority' shall forward records of the case to the 'appellate authority'.
(5) Within 14 days of the receipt of the copy of ihe Memorandum of appeal, the opposite party shall submit his comments on each paragraph of the Memo randum with additional pleas if any , to the appellate authority with a copy to the appellant.
(6) The appellate authority shall record its decision after giving the parties to the appeal a reasonable opportunity of being heard. A copy of the decision shall be given to the parties to the appeal and a copy thereof shall be sent lo the 'controlling authority' returning his records of the case.
(7) The 'controlling authority' shall, on receipt of the dec;sion of the appellate authority, make necessary entry in the records of the case· maintained in Form 'Q' under sub-rule (1) of rule 16.
( 8) On receipt of the decision of the appellate authority , the controlling authority shall, if required under that decision, modify his direction for payment of gratuity and issue a notice to the employer concerned in Form 'S' specifying the modified amount payable and directing payment thereof to the applicant. under intima Uon to the controlling authority within fifteen days of the receipt of the notice by the employer. A copy of the notice shall be endorsed to the applicant employee, nominee or legal heir, as the case may be and to the appellate authority.
19. Where an employer fails to pay the gratuity due under the Act in accordance with the notice by the controlling authority under rule 17 or rule 18, as the case may be, the employee concerned, his nominee or legal heir , as the case may be, to whom the gratuity is payable may apply to the controlling authority in dupli cate in Form 'T' for recovery thereof under section 8 of the Act.
20. The employer shall display an abstract of the Act and the rules made thereunder in English and in the language understood by the majority of the employees at a (:onspicuous place at or near the main entrance ofl the establishment.
• 10 FORM 'A' [See sub-rule (1) of rule 3] Notice of Opening.
1. Name and address of the establishment.
2. 1 Tame and designation of the employer.
3. Number of persons employed.
4. Maximum number of persons emplyed on any day during the preceding twelve months with date.
5. Number of employees covered by the Act.
6. Nature of industry.
7. 'Vhether seasonal.
8. Date of opening.
9. Details of Head Office/branches.
(a) Name and address of the Head office
(b) ~ames & addresses of other branches in India.
1.
2.
3.
Number of employees.
I verify that the information furnished above is true to the best of my knowledge and belief .
Place Date Signature of the employer with name and designation.
To The Controlling Authority, ......................................
···································· • 11 FORM 'B' [See sub-rule (2) of rule 3] Notice of change Name and address of the establishment.
Take notice that following changes have taken place with effect from . . .. .. . ............ . ... .in the particulars furnished by me in notice dated ..... ... .......... on Form 'A'.
Name.
Address:
1\ arne of the employer :
1 ature of business :
Place.
Date.
Signature of the employer with name and designation.
To The Controlling Authority, FORM 'C' [See sub-rule (3) of rule 3] Notice of Closure Take notice that it is intended to close down the establishment with effect from . ... .............. The other details are furnished below :-
1. Name and address of the establishment.
2 . Name and address of the Head Office, if any.
3 . Name and designation of the employer.
4 . Number of persons in employment.
5. Number of employees entitled to gratuity.
6 . Amount of gratuity involved.
Place Date To The Controlling Authority , Signature of the employer with name and designation.
" L2 FORM 'D' (See sub-rule (1) of rule 5] Notice for excluding husband from family From-
1. Name of the feinale employee.
2. Name or description of establishment where employed.
3. Post held with Ticket or serial No., if any.
4. Department/Branch/Section ·where employed.
5. Permanent address.
Take notice thal I , Shrimati---- desire to exclude my husband Shri from my family for the purpose o'f the Payment of Gratuity Act, 1972.
Place.
Dale.
Signature/ thumb impression of the employee.
Declaration by witnesses The above notice was signed/thumb impressed before me.
N arne in full and full address of witnesses.
1.
2.
Signature of witnesses.
1.
2.
• Place.
Date TO The Controlling Authority (through the employer) ( 1 ' arne and address of the employer here) For use by the employer Received and recorded in this establishment.
Reference No.
Date To
1. (Employee) .
Signature of the employer or an officer autho rised in this behalf by the employer.
2. The Controlling Authority.
Note :- Strike out the words not applicable.
13 FORM 'F' [See sub-rule (2) of rule 5] Notice of withdrawal of notice for excluding husband from family.
1. Name of the female employee.
2. Name or description of establishment where employed.
3. Post held with Ticket or Serial No., if any.
4. Department/Branch/Section where employed .
5. Permanent address.
Take notice that I, Shrimati---- , hereby withdraw the notice dated whereby I exclude my husband Shri from my family for the purposes of the Payment of Gratuity Act, 1972.
The earlier notice was recorded under your reference No.--- dated---- Place Date Signature/Thumb impression of the employee.
---- - --··-·----------------------- Declaration by witnesses The above notice of withdrawal was signed/ thumb impressed before me .
'arne in full and full address of witnesses.
Signature of witness.
1.
2.
• Place Date To
1.
2.
The Controlling Authority (through the employer) ( r arne and address of 1he employer).
For use by the employer Received and recorded in this establishment.
Reference No.
Date To
1. (Employee).
Signature of the employer or Officer authorised.
Seal or rubber stamp of the establishment.
2. The Controlling Authority.
Note :- Strike out the words not applicable.
• 14 FOR;\I .F.
[See sub-rule (1) of rule 6] Nomination To (Give here name or description of the establishment with full address).
I, Shri/Shrimati/Kumari---· (name in full here) whose particulars are given in the statement below, hereby nominate the person (s) mentioned below to receive the gratuity payable after my death as so the gratuity standing to my credit in the event of my death before that amount has become payable, or having become pay able has not been paid and direct that the said amount of gratuity shall be paid in proportion indicated against the name(s) of the nominee ( s) .
2. I hereby certify that the person (s) mentioned is/are member (s) of my family within the meaning of clause(h) of section (2) of the Payment of Gratuity Act, 1972.
3. I hereby declare that I haYe no family within the meaning of clause(h) of section (2) of the said Act.
4. (a) My father/mother/parents is/are not dependent on me.
ib ) 1\Iy husband's father/mother/parents is/are not dependent on my husband.
5. I have excluded my husband from m y family by a notice dated the .. . . .. ........ .... to the controlling authority in terms of the proviso to clause (h ) of section 2 of the said Act.
6. Nomination made herein in\'alidates my previous nominotion.
Name in full with full address of nominee(s)
1.
2.
3.
4.
NOMINEE(S) Relationship with the Age of employee nominee 2 3 Statement L Name of employee in full.
2. Sex.
3. Religion.
Proportion by which the gratuity will be shared 4 15
4. Whether unmarried/married/widow/widower.
5. Department/Branch/Section where employed.
6. Post held with Ticket or Serial No .. if any.
7. Date of appointment.
8. Permanent address.
Village Post Office Thana District Sub-division State Place Dale Signature/Thumb impression of the employee.
Declaration by witnesses.
Nomination signed/thumb impressed before me.
N arne in full and full address of witnesses.
1.
2.
Place.
Date.
Signature of witnesses.
1.
2.
Certificate by the employer.
• Certified that the particulars of the above nomination have been verified and rerorded in this establishment.
Employer's Reference No. , if any.
Date ---------- Signature of the employer/officer authorised.
Designation.
Name and address of the esta blishment or rubber stamp thereof.
Acknowledgement by the employee Received the duplicate copy of nomination in Form F field by me and duly certified by the employer.
Dale ........ ... ... . Signature of the employee Note : Strike out the words/paragraph not applicable.
• 16 FORM 'G' [See sub-rule (3) of rule 6] Fresh Nomination.
c To (Give here name or description of the establishment with full address).
I, Shri/Shrimati .................. whose particulars are given in (Name in full here) the statement below, have acquired a family within the meaning of clause (h) of section 2 of the Payment of Gratuity Act, 1972 .............. .
with effect from the ............ (date here) in the manner indicated below and therefore nominate afresh the persons(s) mentioned below to recein the gratuity payable after my dealh as also the gratuity standing Lo my credit in the event of my death before that amount has become payable, or having become payable has not been paid direct that the said amount of gratuity shall be paid in proportion indicated against the name ( s) of Lhe nominee ( s) .
2. I hereby certify the person(s) nominated is/are members(s) of my family within the meaning of clause (h) of section 2 of the said Act.
•
3. (a) 1\ly father/mother/parents is/are not dependent on me.
(b) My husband's father/mother/parents is/are not dependent on my husband.
4. I have excluded my husband from my family by a notice dated the . . . . . . . . . . . . to the controlling authority in terms of the proviso to clause (h) of section 2 of the said act.
Name in full with full address of nominee(s)
1.
2.
3.
so on NOMINEE(S) Relationship with the Age of Proportion by which the employee nominee gratuity will be shared 2 3 4 Manner of acquiring a "family" (Here give details as Lo how a family was acquired i.e., whether by marriage or parents being rendered dependent or through other process like adoption).
• 17 Statement
1. N arne of the employee in full.
2. Sex.
3. Religion.
4. Whether unmarried/married/widow /widower.
5. Department/Branch/Section where employed.
G. Post held with Ticket No. or Serial No. , if any.
7. Date of appointment.
8. Permanent address :
Village Post Office Thana District Sub-Division State Place .............. . Signature/thumb impression of the employee.
Dale ................. .
-----.;;:---- ----- Declaration by witnesses Fresh nomination signed/thumb impressed before me.
Name in full and full address of witnesses.
1 ......... .. ....... .
2 .................. .
Place ... .. ........ .
Date .............. .
Signature of witnesses 1 ................. .
2 ............•.....
Certificate by the employer.
Certified that Lhe particulaTs of the abO\'e nomination have been yarified and recorded in this establishment.
Employer's Reference ro., if any.
Signature of authorised.
Designation.
Name and blishment thereof.
the employer/officer address of the esta or rubber stamp Acknowledgement by the employee.
Received the duplicate copy of U1e nomination in Form .............. .
filrd by me on ............ duly certified by the employer.
Date ................. . Signature of the employer.
Note :-Strike out words and paragraphs not applicable.
To 18 FORM "H' [See sub-rule (4) of rule 6] Modification of nomination.
(Give here name or description of the establishment ·with full address) I, Shri/Shrimati/Kumari ...... _ ....................... .
(Name in full here) whose particulars are given in the statement below, hereby give notice that the nomination filed by me on ............. :.; ...• (Date) and recorded under your reference No ................... dated ................. .
shall stand modified in the following manner :- (Here give details of the modification intended) --------------------~---- ---- Statement.
1. Name of the employee in full.
2. Sex.
3. Religion.
4. Whether unmarried/marriPd/widow /widower.
5. Department/Branch/Section where employed.
6. Post held with Ticket ='l"o. or Serial No., if any.
7. Date of appointment.
8. Address in full.
- ------ ------ --"- Place ......... ...... .. . Signature/thumb impression of the employee.
Date .................... .
Declara Lion by witnesses.
Modification of nomination signed/thumb impressed before me.
N arne in full and full address of witnesses.
1 ................. .
2 .. : .............. .
Place ............ .
Date .............. .
Signature of witnesses.
1 ................. .
2 ................. .
Certificate by the employer.
Certified that the nbove modifications have been recoTded.
Employer's reference No., if any. Signature of the Employer/Officer authorised.
Designation.
Name and add1·ess of the establish ment or rubber stamp thereof.
Acknowledgement by the employee.
Received th~ duplicate copy of the notice 'for modification in Form II filed by me on ........ .... duly certified by the employer.
Dale . . . . . . . . . ....... .. Signature of the employee.
:\ole :-Strike out Lhe words not applicable.
To 19 FORM 'I' [See sub-rule ( 1) of rule 7] Application for gratuity by an employee.
(Give here name or description of the establishment with full address).
Sir/Gentlemen.
I beg to apply for payment of gratuity to which I am entitled under sub-section (1) of section 4 of the Payment of Gratuity Act, 1972 on account of my superannuation/retirement/resignation after comple- ~ tion of not less than five years of continuous service/total disablement due to accident/total disablement due to disease with effect from the .... : .......... Necessary particulars relating to my appointment in the establishment are given in the statement below:
• Statement.
1. Name in full.
2. Address in full.
3. Department/Branch/Section where last employed.
4. Post held with Ticket No., or Serial No. , if any.
5. Date of appointment.
6. Date and cause of termination of service.
7. Total period of service.
8. Amount of wages last drawn.
9. Amount of gratuity claimed.
2. I was rendered totally disabled as a result of .............. .
(Here give the details of the nature of disease or accident) The evidences /witnesses in support of my total disablement are as following :- (Here giYe details)
3. Payment may please be made in cash/open or crossed bank cheque.
4. As the amount of gratuity payable is less than Rupees one thou sand. I shall request you to arrange for payment of the sum due to me by postal Money Order at the address mentioned above after deducting postal money order commission therefrom.
Place ................. .
Date ....... ............. .
Yours faithfully, Signature/ thumb impression of the applicant employee.
Notes :-(1) Strike out the words not applicable.
(2) Strike out paragraph or paragraphs not applkable.
• To 20 FORM 'J' [See sub-rule (2) of rule 7] Application for gratuity by a nominee (Give here the name or description of the establishment with full address).
Sir/Gentlemen, I beg to apply for payment of gratuity to which I am entitled under sub-section (1) of section 4 of the Payment cf graiuity Act, 1972 as a nominee of late ---------- who was an employee of (Name of the employee) your establishment and died on the ------. The gratuity is payable on account of the death of the aforesaid employee while in service/superannuation of the aforesaid employee on----- retirement or resignation of the aforesaid employee on----- after completion of ----- years of service/total disablement of the aforesaid employee due to accident or disease while in service with efJect from the----. I'\ccessary particulars relating to my claim are given in the statement below :
1.
2.
3.
4.
5.
6.
7.
8.
9 .
10.
11.
12 ..
13.
14.
15.
16.
2.
are STATEMENT 1 • ame of applicant nominee.
Address in full of the applicant nominee .
Marital status of the applicant nominee.
(Unmarried/married/widow/widower).
Name in full of the employee.
Marital status of employee.
Relationship of the nominee with the employee.
Total period of service of Lhe employee.
Date of appointment of the employee.
Date and cause of termination of service of employee.
Deparment/Branch/Section where the employee last worked.
Post last held by the employee with Ticket or Serial No., if any.
Total wages last drawn by the employee.
Date of death and evidence/witness as proof o'f death of the employee.
Reference No. of recorded nomination, if available.
Total gratuity payable to the employee.
Share of gratuity claimed.
I declare that the particulars mentioned in the above statement true and correct to the best of my knowledge and belief.
3. Payment may please be made in Cl'l.sh/crossed or open bank cheque.
4. As the amount payable is less than Rupees one thousand, I shall request you to arrange for payment of the sum due to me by postal Money Order at the address mentioned above after deducting postal money order commission therefrom.
Yours faithfully, Signature/thumb impression of applicant nominee.
Place:
Date:
1.
2.
Strike out the words not applicable.
Strike out the paragraph or paragraphs not applicable.
• To 21 FORM 'K' [See sub-rule (3) of rule 7] Application for gratuity by a legal heir.
(Give here the name or description of the establishment with full address).
Sir/Gentlemen.
I beg to apply for payment of gratuity to which I am entitled under sub-section ( 1), of section 4 of the Payment of Gratuity Act, 1972 as a legal heir of late---------- (Name of the employee) who was an employee of your-----establishment and--- died on the without making any nomination. The gratuity is payable on account of the death of the aforesaid employee retirement or resignation of the aforesaid employee on the--- retirement or resignation of the aforesaid employee on the after completion of---------------years of service/ total disablement of the aforesaid employee due to accident or disease while in service with effect from the-----Necessary particulars relating to my claim are given in the Statement below :
1.
2.
3.
4.
5.
6.
7.
8 .
9.
10.
11.
Statement.
Name of applicant legal heir.
Address in full of applicant legal heir.
Marital status of the applicant legal heir (Unmarried/married/widow/widower).
Name in full of the employee.
Relationship of the applicant with the employee.
Religion of both the applicant and the employee.
Date of appointment and period of service of the employee.
Department/Branch/Section where the employee worked last.
Post last held by the employee with Ticket or Serial No., if any.
Total wages last drawn by the employee.
Dale and cause of termination of service of the employee.
fdealh or otherwise).
12. Dale of death of the employee and evidence/witness in support
13.
14.
15.
2.
3.
4.
thereof.
Total gratuity payable lo the employee.
Percentage of the gratuity claimed.
Basis of the claim and evidence/witness in support thereof.
I declare that the particulars mentioned in the above Siatement are true and correct to the best of my knowledge and belief.
Payment may please be made in cash/open or crossed bank cheque As the amount payable is less than Rupees one thousand I shall request you to arrange for payment of the sum due to me by postal Money Order at the address mentioned above, after deduct ing postal money order commission therefrom.
Place : Date:- Yours faithfully, Signature/thumb impression of applicant legal heir.
Note :-Strike out the words not applicable:
• ")') FORM 'L' (See Clause (i) of sub-rule (1) of rule 8] Notice for payment of gratuity fo:
(Name and address of the applicant employee/nominee legal heir) You are hereby informed as required under clause (i) of sub rule (1 ) of rule 8 of the Tripura Payment of Gratuity Rules, 1974 !hat a sum Rs ............................... (Rupees), is payable lo ~·ou as gratuHy/as your share of gratuity in terms of nomination.
n13de by in this Est a!Jlishmcnl.
on as a legal heir of an employe;; of this and recorded
2. Please call at on (Here specify place) (dale) at ........................ for collecting your payment in cash/open or crossed cheque.
(time)
3. Amount payable shall be sent to you by postal Money order at the address giYen in your application after deducting the postal money order commission, as desired by you. by Brief statement of calculation.
1. Total period of service of the employee concerned : - - ------------years-------------- months.
2. \Vages last drawn.
3 . Proportion of the admissible gratuity payable in terms of nomina Lion/as a legal heir.
4. Amount pavable.
Place Dale- Signature of the employer/Authorised Officer, ~arne or description of establishment or rubber stamp thereof.
Copy to the Controlling Authority.
Note :-Strike out the words not applicable.
& • 23 FORM 'M' [See Clause (ii) of sub-rule (1) of rule 8] Notice rejecting claim for payment of gratuity To (Name and address of the applicant employee/nominee legal heir) Your are hereby informed as required under clause (ii) of sub rule (1) of rule 8 of the Tripura Payment of Gratuity Rules, 1974 that your claim for payment of gratuity as indicated on your application in Form . . . . . . . . . . . . under the said rules is not admissible for the reasons stated below :
Place Date- REASONS {Here specify the reasons) Signature of the employer/ Authorised Officer. · Name or description of establishment or rubber stamp thereof.
~opy to the Controlling Authority.
Note :-Strike out the words not applicable .
24 FORM 'N' [See sub-rule (1) of rule 10] Application for direction Before the Controlling Authority under the Payment of Gratuity Act, 1972.
Application No. Date Between (Name in full of the applicant with full address) And ( rame in full of the employer concerned with full address) The applicant is an employee of the above-mentioned employers nominee of late . . . . . . . . . . . . . . . . . . an employee of the above-mentioned employer's legal heir of late .................. and employee of the abov~- menlioned employer, and is entitled to payment of gratuity under section 4 of the Payment of Gratuity Act, 1972, on account of his own/ aforesaid employee's superannlljltion on (date)/his own retirement/ aforesaid employees resignation.
on (date) after completion of ............ years of continuous service/ his own/aforesaid employee's total disablement with effect from ........ .
due to accident/disease death of the aforesaid employee on {date)------
2. The applicant submitted an application under rule of the Tripura • Payment of Gratuity Rules, 1974 on the but the aboYe-menLioned employer refused to entertain it issue<J a notice dated the under clause of sub-rule of rule ofl'ering an amount of gratuity which is less than my due/issued a notice dated the under clause of sub-rule of rule rejecting my eligibility to payment of gratuity. The duplicate copy of the notice is enclosed.
3. The applicant submits that there is a dispute on the matter (specify the dispute).
4. The applicant furnishes the necessary particulars in the annexure hereto and prays that the Controlling Authority may be pleased to determine the amount of gratuity payable to the petitioner and direct the above-mentioned employer to pay Lhe same to the petitioner.
5. The applicant declares that the particulars furnished in the annexure hereto are true and correct to the best of his knowledge and belief.
Date Signature of the applicant/Thumb impression of the applicant.
• • 25 ANNEXURE
1. Name in 'full of applicant with full address.
2. Basis of claim (Death/Superannuation/Retirement/Resignation/Disablement of employee).
3. Name and address in full of the employee.
4. Marital status of the employee
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
(unmarried/married/widow /widower) .
N arne and address in full of the employer.
Department/Branch/Section where the employee was last em ployed (if known).
Post held by the employee with Ticket or serial Nb. , if any (if known).
( Date of appointment of the employee (if known).
Date and cause of termination of service of the employee (Super annuation/retirement/resignation/disablement/death) .
Total period o'f service by the employee.
Wages last drawn by the employee.
If the employee is dead, date and cause thereof.
Evidence/witness in support of death of the employee.
If a nominee , No. and date of recording of nomination with the employee .
Evidence/witness in support of being a legal heir, if a legal heir.
Total gratuity payable to the employee (if known).
17. Percentage of gratuity payable to the applicant ai a nominee/ legal heir.
18. Amount of gratuity claimed by the applicant.
Place Date Signature/Thumb impression of the applicant.
Note :-Strike out the words not applicable.
26 FORM '0' [See sub-rule ( 1) of rule 11] Notice for appearance before the controlling authority.
Form :- The Controlling Authority under the Payment of Gratuity Act,
1972.
To:- (Name and address of the employer/applicant) Whereas Shri , an employee under you/a nominee(s) legal heir(s) of Shri an employee under the above mentioned employer, has/have filed an application under sub-rule (1) of rule 10 of the Tripura Payment of Gratuity Rules , 1974 alleging that (A copy of the said application is enclosed) Now, therefore, you are hereby called upon to appear before me at (place) either personally or through a person duly authorised in this behalf for the purpose of answering all material questions relating to the application on the day of 19 at 0' clock in the forenoon/afternoon in support of/to ans\ver the allegation ; and as the day fixed for your appearance is appointed for final disposal of the application , you must be prepared to produce on that day all the witnesses upon whose evidence, and the documents upon which you intend to rely in support of your allegation/defence .
• Take notice that in default of your appearance on the day before mentioned the application will be dismissed/heard and determined in your absence.
Given under my hand and seal, this day of 19 Controlling Authority.
Note :-Strike out the words and paragraphs not applicable.
27 F-oRM 'P' (See rule- til').
SUMMONS Before the Controlling Authority under the Payment of Gratuity Act, 1972.
To (Name and address) Whereas your attendance is reqUired to give evidence/you are required to produce the documents mentioned in the list below oii ------in the case arising out of the claim'for gratuity by--- f!1om and referred to this Authority by an application under section 7 of the Payment of Gratuity Act, 1972, you are hereby summoned to appear personally before this Authority on the day of-19 at O'Clock in tli:e forenoon/afternoon and to bring with you (or to sent to this authority) the said documents.
LIST OF DOCUMENTS
1.
2.
:+. so on Controlling Authority.
Dated this day ol 19 Note :-(1) The portion not applicable to be deleted.
(2) The summons shall be issued in duplicate. The duplicate is to be signed and returned by the person served before the date fixed.
(3) In case the summons is issued only for producing a docu ment and not to give evidence, it will be sufficient compli ance to the summons if the documents are caused to be produced be£ore the controlling authority on the day and hour fixed for the purpose.
• 28 FORM '9:
[See sub-rule (1) of rule 16] Particulars of application under section
1. Serial No.
2. Date of the application.
3. N arne and address of the applicant.
4. Name and address of the employer.
5. Amount of gratuity claimed.
6. Dates of hearing.
7. Finding with date.
8. Amount awarded.
~
9. Cost, if any, awarded.
10. Date of notice issued for payment of gratuity.
!1. Date of appeal, if any.
12. Decision of the appellate authority.
13. Date of Issue o'f Final Notice for payment of gratuity.
14. Date of payment of gratuity by employer with mode of payment.
15. Date of receipt of application for recovery of gratuity .
16. Date of issue of recovery certificate.
17. Date of recovery.
18. Other remarks.
19. Signed.
20. Date.
• To 29 FORM 'R' (See rule 17) (Name and address of employer) Whereas Shri /Smti./Kumari of (address) an employee under you/a nominee(s) legal heir(s) of late an employee under you, filed an application under section 7 of the Payment of Gratuity Act, 1972 before me ;
And whereas the application was heard in your presence on and after the hearing I have come to the finding that the said Shri/Smti/ Kumari is entitled to a payment of Rs. as gratuity under the Pay ment o"f Gratuity Act, 1972 ;
:\ow. therefore, l hereby direct lo pay the said sum of Rs.
to Shri/Smt./Kumari .................. within thirty days of the receipt of this notice with an intimate thereof to me.
Give under my hand and seal, this day of 19 Controlling Authority .
-:..upy to :
__. (Applicant under rule) He is ach·ised to contract the employer for collecting payment.
Note :- The portion not applicable to be deleted.
30 FORM'S' [See sub-rule (8) of rule 18] Notice for payment of Gratuity as determined by appellate Authority - To (Name and address of employer) \Vhereas a notice was given to you on you to make a payment of Rs.
form 'R' reqmrmg as gratuity under the payment of Gratuity Act, 1972 ;
\:Vhereas you/the applicant went in appeal before the appellate authority, who has decided that an amount of Rs ............. is clue to be paid to Shri/Smt./Kumari as gratuity due under the Payment of Gratuity Act, 1972 ;
0:ow. therefore. I hereby direct you to pay the said sum of Rs. to Shri/Smt./Kumari within 30 clays of the receipt of this notice with an intimation thereof to me.
Given under my hand and seal, this day 19 Controlling Authority .
• Copy to:-
1. The applicant He is advised to contact the employer for collecting payment.
2. The Appellate Authority.
Note :-The portion not applicable to be deleted.
..
• 31 FORM I (See Rule 19) Application for recuvery of gratuity. -- Befon• the Controlling Authority under the Payment of Gratuity Act, 1972.
Application " o. Date Between (."arne in full of the employer with full address).
The applicant is an employee of the abow-mentioned employer/ a nominee of late an employee of the abovementioned employer/legal heir of late an employee of the above-mentioned employer, and you were pleased to direct the said uuplo:yer in your notice dated lhe- - -- -under ruk -or the Tripura Payment d Gratuity Hules. 1\JI.) lor p,t~ mutl <,I a :,um of lb. as gratuity payable under lhe Payment of Gratuity Act, 1972.
~. The applicant submit" lhal llw :mid l·mployer failed lo pay the S<l'cl amount of gratuity to me as direclcd by you although I approached him for payment.
3. The applicant therefore prays that a certificate may be issued under section ------ of the said Act for recovery of the said sum of Rs. ---- due to me as gratuity in terms of your direction .
Place Date Signature/Thumb impression of the applicant.
• "ote :-Strike out the words not applicable.
By order of the Governor.
D. N. BARUA Secretary, Government of Tripura.
Printed at the Tripura Govern ment Pres , Agartala.